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Chest Imaging

E1044. Revised Fleischner Society Guidelines for the Management of Incidental Pulmonary Nodules

Nolan P,  Zangan S. University of Chicago, Chicago, IL

Address correspondence to P. Nolan (

Background Information: The 2005 Fleischner Society guidelines provided evidence-based criteria for the management of small pulmonary nodules detected on CT based on nodule size and patient risk factors for malignancy, with additional guidelines for subsolid nodules published in 2013. New data accumulated from several large studies required revisions to these guidelines, which include increased minimum threshold size for routine follow-up, guidelines for the management of ground-glass nodules, and specific recommendations for multiple nodules. In addition, follow-up intervals are now given as a range rather than a precise time period to give radiologists, clinicians, and patients greater discretion based on individual risk factors and patient preferences. Accurate characterization and measurement of pulmonary nodules is essential to utilizing these guidelines. This educational exhibit will review the revised Fleischner Society guidelines for the management of incidental pulmonary nodules, define and provide examples of the different categories of pulmonary nodules, demonstrate the appropriate method for measuring nodules to ensure reliable and reproducible dimensions, and provide a case-based review of the appropriate management of incidental pulmonary nodules.

Educational Goals/Teaching Points: The education goals of this exhibit are to inform radiologists about the updates to the Fleischner Guidelines for the management of incidental pulmonary nodules and to reinforce how pulmonary nodules are appropriately characterized and measured.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The revised Fleischner guidelines apply to pulmonary nodules incidentally detected on CT and stratify patients based on nodule size, nodule characteristics, and patient risk factors in order to determine the next appropriate course of action.

Conclusion: The 2017 revisions to the Fleischner Society guidelines aim to improve the management of incidentally detected pulmonary nodules based on the accumulation of new evidence since the original publication in 2005. The new guidelines better clarify management according to nodule characteristics (e.g., solid, part-solid, ground-glass) and nodule multiplicity. Increased size threshold for the routine follow-up of solid nodules will hopefully reduce the number of unnecessary follow-up examinations. The accurate measurement and characterization of pulmonary nodules using contiguous 1mm sections is essential to the proper application of these guidelines.